Healthcare Provider Details

I. General information

NPI: 1306800826
Provider Name (Legal Business Name): KEELAN ENSEKI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 06/15/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 S WATER ST
PITTSBURGH PA
15203-2307
US

IV. Provider business mailing address

2027 CAREY WAY
PITTSBURGH PA
15203-2002
US

V. Phone/Fax

Practice location:
  • Phone: 412-432-3700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT015174
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: